Examining Social Determinants of Undiagnosed Diabetes in Namibia and South Africa Using a Behavioral Model of Health Services Use

Diabetes Res Clin Pract. 2021 Apr 16:108814. doi: 10.1016/j.diabres.2021.108814. Online ahead of print.

ABSTRACT

AIMS: To examine factors associated with undiagnosed diabetes in Namibia and South Africa.

METHODS: This study used the most recent Demographic and Health Surveys (DHS) from Namibia (2013) and South Africa (2016). This study focused on adults at 35-64 years old. Using Andersen’s Behavioral Model, potential contributing factors were categorized into predisposing factors (sex and education), enabling factors (wealth, health insurance, and residence), and a need factor (age, BMI, and high blood pressure). Separate multivariable logistic regression models were used to examine factors associated with undiagnosed diabetes in Namibia (N=242) and South Africa (N=525).

RESULTS: In Namibia, higher odds of having undiagnosed diabetes were associated with rural residence (adjusted odds ratio (aOR)=2.21) and age younger than 45 years old (aOR=3.20). In South Africa, odds of having undiagnosed diabetes were higher among the poorest-to-poorer group than it was in the richer-to-richest group (aOR=2.33). In both countries, having high blood pressure was associated with lower odds of having undiagnosed diabetes (aOR=0.31 in Namibia; aOR=0.21 in South Africa).

DISCUSSION: Different enabling and need factors were associated with undiagnosed diabetes in these two countries, which implies potentially-different mechanisms driving the high prevalence of undiagnosed diabetes, as well as the needs for different solutions.

PMID:33872630 | DOI:10.1016/j.diabres.2021.108814